ISUOG Outreach volunteer Alice Robinson (far right) in Papua New Guinea with one of the trainees (Image courtesy of Nayana Parange)

ISUOG Outreach and the Australasian Society of Ultrasound in Medicine (ASUM) conducted an Outreach mission in Port Morsby, Papua New Guinea in October 2016. As a first time volunteer for ISUOG Outreach and ASUM, Alice Robinson of Australia explains her experience in empowering other practitioners with ultrasound.

Flying into Port Moresby Airport, I found a hive of activity; many of the travellers were expats arriving back to Papua New Guinea (PNG) for a variety of reasons – leading fishing charters, managing a food distribution company, working in a local school, whilst others were visiting PNG for tourism, which extends to bird watching in the highlands and walking the Kokoda track. Brief interactions with these fellow travellers made me think I had underestimated the resources available to this small country, which lies just a hop, skip and jump from the northern tip of my own home country, Australia (150km to be more precise).

Papua New Guinea has a maternal mortality rate of 250 per 100,000, one of the highest in the Western Pacific region, and a high fertility rate of 3.8 births per woman, which is double that of Australia’s fertility rate. The role of ultrasound in the overall care of women and children in PNG needs to be put in the context of these staggering figures, and is certainly vastly different from the role of ultrasound in Australian medical practice.

Spending five days at Port Moresby General Hospital and teaching ultrasound to a dedicated group who had traveled far to attend the course made me realise I had overestimated the resources allocated to maternal health and safety. The doctors, midwives, and supporting healthcare staff who we had the privilege of meeting during the program provide an amazing service to the women of PNG despite limited supplies and challenging circumstances.

With all this in mind, my three colleagues and I (brought together by the Australian Society of Ultrasound in Medicine – ASUM – Outreach Committee), tailored a basic OB/GYN ultrasound course for the nine rural healthcare professionals we trained. Despite the four tutors originating from Australia, we come from different corners of the country and gained our medical, ultrasound, and teaching skills via varied pathways. It was such a pleasure to work with like-minded professionals who brought very different attributes and skills to the course, such as Nayana Parange (PNG Project leader) who’s prior experiences in PNG were particularly beneficial in understanding the local healthcare system and how our course could be most beneficial.

As we took the trainees through tutorials (two or three per day) and practical sessions (three-four hours per day), it became apparent that their enthusiasm and hunger for knowledge was not only due to their impending exams (to achieve a Diploma in Gynecology and Obstetrics), but also due to the direct applicability of new ultrasound skills to each of their clinical practices. The small group practical sessions were a highlight, with two to three trainees per tutor, and a long line of patients from the outpatient clinics and inpatient wards at the hospital. This gave us the opportunity not only to meet some delightful local women, but to see each of the trainees improve individually over the next four days.

The many stories that were told over the course of the program highlighted that ultrasound will be another useful tool at the disposal of these talented doctors. A perfect example is one participant who had recently undertaken carpentry and plumbing training, skills which seemed as vital as any medical technology in keeping his remote health centre running smoothly.

Looking to the future, we hope that this brief training course will give participants the ultrasound skills to save lives and improve management in women’s health. This will require ongoing support and feedback for the trainees, which we are planning to provide with online discussions, and refresher courses during subsequent visits.

I feel privileged to have been involved in the first joint ASUM/ISUOG ultrasound training course in PNG. The involvement of both organisations ensured a structured approach and collaboration between all parties to achieve a common goal. Our glimpse into PNG life was very educational, and I hope we were able to teach the trainees as much about ultrasound as they taught us about overcoming the difficulties of working in the country’s rural areas.

Humbling. Elating. Empowering. That is how I would describe my first Outreach mission with ISUOG to Sudan.

Gesu Antonio Baez introducing ISUOG Outreach

From the moment our team of trainers met, it was obvious how compatible we all were with our different ethnic backgrounds and personal experiences. Under the watchful eye of ISUOG’s phenomenal Gesu Antonio Baez, and the leadership of insightful Dr. Mirghani, we knew that this was destined to be a most impactful mission for all involved.

On the Lakeshore of Rahad

Humbling it was to be received by the warmest most genuine people of Sudan who welcomed us like royalty, and escorted us with pride all over Al Obeid and North Kordofan State. Despite the logistical challenges, they made sure we had the most comfortable accommodations and an organized clinic set up with all the necessities in place, not to mention the unforgettable “Jebana” coffee. The Minister of Health, his Excellency Dr. Abdullah Faki Omer, never left our team: from receiving us at the airport to escorting us as we departed. Dr. Khidir was the driving force behind our entire mission on the Obeid front: the true embodiment of commitment and dedication.

Rahad Lake

Elating it was to have the privilege to participate in the sonographic education of 30 most dedicated Ob/Gyn and Radiology Physicians who had come from all over North Kordofan State to attend our 5 intense days. We had their undivided attention whether it was during the didactic or the hands-on sessions. They had such a hunger and eagerness to learn, and were so receptive to any instruction or criticism to help them improve their sonographic skills. The trainees were divided into 4 groups and rotated on a daily basis with the trainers. On the last day, each team of trainees ended up with their trainer from the first day. I had the “Red Team” and it was amazing to have them back with me on the last day: the progress they had made was unbelievable. They were secure and confident in utilizing the systematic 6 Steps Approach, were able to recognize key anatomical landmarks and were able to manipulate the probe to arrive at the required biometric planes.

Dr. Samira Demonstrating 6 Steps and the Red Team

Empowering it was to be able to play a role, albeit indirect and quite small, in the future of the mothers of Sudan. Visiting the labor ward at the Al Obeid new Maternity Hospital, a referral center for the area, offered us a glimpse of the challenging conditions faced by both physicians and patients. Though all the basic necessities are met, the patients have to secure and purchase key “material” for labor, and they are usually discharged 2 hours postpartum to make room for the other 15-20 daily parturients, not counting the cesarean deliveries. Nonetheless, there is an unshakable commitment from the Sudanese Government led by the Ministry of Health, and an army of health care providers dedicated to improving the maternal and neonatal mortality rates and their co-morbidities. It was most empowering for me, as a member of the ISUOG Outreach Team, to be a part of Sudan’s vision for a future where every woman has access to a properly performed sonographic examination in order to identify and safeguard against the major contributors to maternal morbidity and mortality.

Our Entire Team

Humbled. Elated. Empowered. That is how I feel. That is what Sudan and its beautiful people have left me with. I feel honored and privileged and I eagerly look forward to our next mission amongst the most gracious Sudanese…

Day Three of the Outreach Program in Sudan had an exciting start! After a lecture on placental assessment by Prof. Hisham Mirghani, the trainees broke off into their teams. Outreach Trainer Yasmin Casmod’s group identified two anomaly scans (one which was oligohydramnios with abnormally large eyes and heart), which had to be immediately consulted over to Dr Sami Mahmoud to oversee and recommend follow up accordingly.

We’re on with day two with ISUOG Outreach in Sudan. The morning saw practical training for the most part, with trainees divided amongst the trainers. Each group had an average of six patients and the instructors focused on helping trainees understand how they will be assessed on ultrasound competency.

The trainees also conducted a pre-test in 1st and 2nd/3rd trimester ultrasound in order to measure and understand their current knowledge in OB/GYN ultrasound scanning. Lectures today focused on early pregnancy, 1st trimester and abnormal pregnancies. The team had the chance to hear a lecture on abnormal early pregnancy from Observer and Trainer, Dr Sami Mahmoud who is Secretary General of the African Federation of Obstetrics and Gynecology (AFOG).

Sunday the 13th of November kicked off the ISUOG Outreach program in El Obeid, Sudan with 30 trainees eager to get started at the Planned Parenthood Headquarters in El Obeid. The morning began with an opening ceremony, presented by the Minister of Health, Dean of the University of Kordofan, along with ISUOG Ambassador Hisham Mirghani and ISUOG International Development Coordinator Gesu Antonio Báez. This was followed by a practical scanning session. And the sessions were big – up to 70 patients were in the waiting room ready to be scanned by the trainees who were also eager to learn.

MindRay generously loaned two machines to the program to enhance the training experience. The rest were provided from local hospitals and were functioning in full form!

Each trainee was divided into groups based on their years of experience with ultrasound in order to provide a tailored approach to their learning. This also allowed them to get to know other trainees who came from afar – some travelled up to five hours from other parts of Sudan!

With day one already a success, the group looks forward to taking the scanning skills of the groups to next level. With hope, it will be a successful week to follow, or as they say in this part of the world “inshallah”.

The purpose of the ISUOG Outreach project to Sudan is to provide ultrasound training to local OB/GYN practitioners with the intention that these trainees eventually become local trainers.

Phase I comprises of three week-long training programs, which will take place in a 12-18 month time frame with a space of 6 months between training. Between training, trainees will be mentored by designated trainers from the project team to provide guidance on scanning. By the end of Phase I, trainees will be competent in ultrasound scanning techniques and conduct quality scans in line with basic training outreach templates (SO2).

ISUOG Outreach is proud to announce its first program taking place in El Obeid, Sudan from 13-17 November 2017. Led by ISUOG Ambassador to UAE and the Middle East, Prof. Hisham Mirghani (UAE/Sudan), the team comprises of Ms. Yasmin Casmod (South Africa), Dr. Angela Ranzini (USA) and ISUOG’s Ambassador to Outreach in Lebanon and the Middle East, Dr. Reem Abu-Rustum (Lebanon). ISUOG’s International Development Coordinator, Gesu Antonio Baez, will also be joining the team in coordinating the project and working with key stakeholders on the ground.

Some exciting news – in partnership with the Australasian Society of Ultrasound in Medicine (ASUM ) on their first Outreach endeavor – ISUOG Outreach will be supporting a program in Port Moresby, Papua New Guinea from 23 October to 27 October. Led by ISUOG Outreach volunteer Dr. Nayana Parange, a team of three from Australia (Dr. Alice Robinson, Dr. Kris Barnden and Dr. Sujatha Thomas) will be training nine trainees from around the area in basic OB/GYN ultrasound at the Port Moresby General Hospital. While they will be working on the current two machines in place, GE Healthcare has partnered with the program to lend portable machines for this endeavor.

Of all the countries in the Asia/Pacific region, Papua New Guinea (PNG) has the highest levels of maternal mortality and has actually shown little (if any) progress on achieving the previous Millennium Development Goals (MDG’s) on reducing maternal mortality at a staggering 230 women dying for every 100,000 (according to HDR 2014 Report). More statistics on PNG can be found here via the World Health Organization.

With the levels of women dying in the country due to preventable causes, providing basic training in OB/GYN ultrasound is vital to help identify issues in advance. Be sure to watch this space as we hear more from the field and provide more updates from the team!

ISUOG Outreach is happy to announce that partner organisation SANA Medical NGO will be collaborating with the University of Balamand in an upcoming art exposition at the university, based in Balamand al Kurah (Lebanon) taking place 18 October. The exposition will feature the art of Issam Elias entitled “Unattainable Dream”. All proceeds will go to SANA Medical NGO. For more information, please see the flyer below and visit SANA Medical NGO’s Facebook page (https://www.facebook.com/SANA-Medical-NGO-154204021313278/)

ISUOG Outreach is happy to announce its Outreach Workshop taking place on Wednesday, 28 September 2016 from 13:50 to 14:50 in the Rome Park Marriott Hotel (in the Botticelli Hub Space). Much like last year, the aim will be to engage with audience members on key topics regarding ISUOG’s development work on the field and to provide a forum of discussion around innovating ways and methods to promote sustainable development in both women’s health and ultrasound training.

Title:Outreach Workshop – teaching ultrasound on the field

Introduction: ISUOG Outreach – where we are at and what has been done (A. Johnson and G. Baez)

Hub 1: Tricks of the trade (A. Johnson)Hub 2: From a distance – a method for ultrasound quality control between continents (H. Feltovitch)Hub 3: Theory vs. Practical – how much of each is needed and where? (T. Cohen-Overbeek)Hub 4: How to strengthen relationships between trainer and trainee (T. Eggebo)

Looking forward to seeing you there are we discuss more on how to impact lives and empower local practitioners on the ground!

Something new is in the air, and we’re excited to share it with you! This year, ISUOG took the exiting initiative to launch for the first time its brand new Travel Grant scheme, aimed to support education and research in under served regions of the world. ISUOG had made available up to five travel grants for young researchers from these regions to attend the 26th World Congress on Ultrasound in Obstetrics and Gynecology that will be held in Rome from 25-28 September 2016.

After a careful selection process, we are happy to announce the following candidates as the winners:

Ehigha Enabudoso (Nigeria)

Jesmin Pervin(Bangladesh)

Nosa Enaruna(Nigeria)

Sikolia Wanyonyi(Kenya)

Arij Bouzid(Tunisia)

The winners will each receive complimentary registration, round-trip travel to Rome, four-nights’ accommodation and will have the opportunity to present their abstract during the 26th World Congress to ISUOG’s global audience. For those attending the World Congress this year, we hope you’ll join us in congratulating these winners for their outstanding achievement. For more information about the travel grant, please visit our page: http://www.isuog.org/WorldCongress/2016/travelgrant/